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Medical Plans

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You Buy Your Own Health Insurance

HealthyBlue encourages greater interaction between you and your Patient-Centered Medical Home (PCMH) primary care provider (PCP) as you both work toward the goal of a healthier you. PCMH was designed to provide you with a more complete view of your health needs, as well as the care you receive from other providers. Partnering with your PCMH PCP can also help you to earn a financial reward – $150 for an individual or up to $400 for a family.

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Plan Highlights
  • Earn $150 per adult or up to $400 per family starting January 1, 2015 upon renewal of your health plan
  • No cost, no copay for preventive care, well-child visits/immunizations and cancer screenings when you access care in-network
  • No referrals required
  • Access to an extensive provider network
  • Out-of-network benefits
Plan Comparison (In- and Out-of-Network Comparison)
HealthyBlue Plans

 

 
Gold $1,500
Platinum $0
Network
In-Network
Out-of-Network
In-Network
Out-of-Network
Provider Network 35,000
BlueChoice providers
and 80 local hospitals
600,000 BlueCard providers and 4,500 hospitals or
Non-participating providers
35,000 BlueChoice providers
and 80 local hospitals
600,000 BlueCard providers and 4,500 hospitals or
Non-participating
providers
PCP Selection Yes Yes Yes Yes
Referrals No No No No
Routine Adult Physical
(includes routine OB/GYN
visits)
$0 Deductible, then $0 $0 Deductible, then $0
Sick Visits
(with PCP)
$0 PCP, no deductible,
$40 Specialist,
no deductible
$40 copay
after deductible
$0 PCP, no deductible
$30 Specialist,
no deductible
$30 copay
after deductible
Well-Child Care
(includes exams
and immunizations)
$0 $0 $0 $0
Mammogram $0 $0 $0 $0
Pap Smear,
Prostate and Colorectal Screenings
$0 Deductible, then $0 $0 Deductible, then $0
Lab, X-Ray, Diagnostic Testing $0 Deductible, then $0 $0 Deductible, then $0
Urgent Care Center (participating) $50 copay
no deductible
$50 copay
no deductible
$50 copay
no deductible
$50 copay
no deductible
Blue Rewards

Blue Rewards Means Money Back

Blue Rewards is launching January 1, 2015 and will be available to you upon renewal of your health plan.

Complete four steps within 120 days of enrolling in HealthyBlue and you will receive your Blue Reward. Earn $150 per adult or up to $400 per family. Each member of your family between ages 2-17 is eligible for a $50 reward.

Complete these four steps to get your Blue Reward:

  1. Select a primary care provider (PCP) who participates in our Patient-Centered Medical Home (PCMH) program—a program that focuses on better management and coordination of your care. (ages 2+)
  2. Agree to receive wellness-related communications electronically. (ages 18+)
  3. Complete an online health assessment. (ages 18+)
  4. Visit your selected PCP and complete your Health and Wellness Evaluation Form. (ages 2+)

Blue Rewards incentive card
Once you complete the steps, you will receive a Blue Rewards incentive card which can be used toward your monthly premium payment, annual deductible or out-of-pocket costs like copays or coinsurance related to eligible expenses under your health plan (medical, prescription drug, dental and vision expenses).

You may also use your Blue Rewards card at approved merchant locations, which include doctor’s offices, pharmacies, dental practices, vision care centers and urgent care centers. The card should only be used to pay for eligible expenses under your health plan, and you should always save your receipts.

Frequently Asked Questions

If you have questions, visit our Frequently Asked Questions.

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